Cargando…

DCIS Margins and Breast Conservation: MD Anderson Cancer Center Multidisciplinary Practice Guidelines and Outcomes

Recent published guidelines suggest that adequate margins for DCIS should be ≥ 2 mm after breast conserving surgery followed by radiotherapy (RT). Many groups now use this guideline as an absolute indication for additional surgery. This article describes detailed multidisciplinary practices includin...

Descripción completa

Detalles Bibliográficos
Autores principales: Kuerer, Henry M., Smith, Benjamin D., Chavez-MacGregor, Mariana, Albarracin, Constance, Barcenas, Carlos H., Santiago, Lumarie, Edgerton, Mary E., Rauch, Gaiane M., Giordano, Sharon H., Sahin, Aysegul, Krishnamurthy, Savitri, Woodward, Wendy, Tripathy, Debasish, Yang, Wei T., Hunt, Kelly K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Ivyspring International Publisher 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5604195/
https://www.ncbi.nlm.nih.gov/pubmed/28928852
http://dx.doi.org/10.7150/jca.20871
_version_ 1783264826131218432
author Kuerer, Henry M.
Smith, Benjamin D.
Chavez-MacGregor, Mariana
Albarracin, Constance
Barcenas, Carlos H.
Santiago, Lumarie
Edgerton, Mary E.
Rauch, Gaiane M.
Giordano, Sharon H.
Sahin, Aysegul
Krishnamurthy, Savitri
Woodward, Wendy
Tripathy, Debasish
Yang, Wei T.
Hunt, Kelly K.
author_facet Kuerer, Henry M.
Smith, Benjamin D.
Chavez-MacGregor, Mariana
Albarracin, Constance
Barcenas, Carlos H.
Santiago, Lumarie
Edgerton, Mary E.
Rauch, Gaiane M.
Giordano, Sharon H.
Sahin, Aysegul
Krishnamurthy, Savitri
Woodward, Wendy
Tripathy, Debasish
Yang, Wei T.
Hunt, Kelly K.
author_sort Kuerer, Henry M.
collection PubMed
description Recent published guidelines suggest that adequate margins for DCIS should be ≥ 2 mm after breast conserving surgery followed by radiotherapy (RT). Many groups now use this guideline as an absolute indication for additional surgery. This article describes detailed multidisciplinary practices including extensive preoperative/intraoperative pathologic/histologic image-guided assessment of margins, offering some patients with small low/intermediate grade DCIS no RT, the use/magnitude of radiation boost tailoring to margin width, and endocrine therapy for ER-positive DCIS. Use of these protocols over the past 20-years has resulted in 10-year local recurrence rates below 5% for patients with negative margins < 2 mm who received RT. Patients with margins < 2 mm who do not receive RT experience significantly higher local failure rates. Thus, there is not an absolute need to achieve wider negative surgical margins when < 2 mm for patients treated with RT and this should be determined by the multidisciplinary team. Utilization of these multidisciplinary treatment protocols and techniques may not be exportable and extrapolated to all hospitals, breast programs and systems as they can be complex and resource intensive.
format Online
Article
Text
id pubmed-5604195
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Ivyspring International Publisher
record_format MEDLINE/PubMed
spelling pubmed-56041952017-09-19 DCIS Margins and Breast Conservation: MD Anderson Cancer Center Multidisciplinary Practice Guidelines and Outcomes Kuerer, Henry M. Smith, Benjamin D. Chavez-MacGregor, Mariana Albarracin, Constance Barcenas, Carlos H. Santiago, Lumarie Edgerton, Mary E. Rauch, Gaiane M. Giordano, Sharon H. Sahin, Aysegul Krishnamurthy, Savitri Woodward, Wendy Tripathy, Debasish Yang, Wei T. Hunt, Kelly K. J Cancer Review Recent published guidelines suggest that adequate margins for DCIS should be ≥ 2 mm after breast conserving surgery followed by radiotherapy (RT). Many groups now use this guideline as an absolute indication for additional surgery. This article describes detailed multidisciplinary practices including extensive preoperative/intraoperative pathologic/histologic image-guided assessment of margins, offering some patients with small low/intermediate grade DCIS no RT, the use/magnitude of radiation boost tailoring to margin width, and endocrine therapy for ER-positive DCIS. Use of these protocols over the past 20-years has resulted in 10-year local recurrence rates below 5% for patients with negative margins < 2 mm who received RT. Patients with margins < 2 mm who do not receive RT experience significantly higher local failure rates. Thus, there is not an absolute need to achieve wider negative surgical margins when < 2 mm for patients treated with RT and this should be determined by the multidisciplinary team. Utilization of these multidisciplinary treatment protocols and techniques may not be exportable and extrapolated to all hospitals, breast programs and systems as they can be complex and resource intensive. Ivyspring International Publisher 2017-08-22 /pmc/articles/PMC5604195/ /pubmed/28928852 http://dx.doi.org/10.7150/jca.20871 Text en © Ivyspring International Publisher This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) license (https://creativecommons.org/licenses/by-nc/4.0/). See http://ivyspring.com/terms for full terms and conditions.
spellingShingle Review
Kuerer, Henry M.
Smith, Benjamin D.
Chavez-MacGregor, Mariana
Albarracin, Constance
Barcenas, Carlos H.
Santiago, Lumarie
Edgerton, Mary E.
Rauch, Gaiane M.
Giordano, Sharon H.
Sahin, Aysegul
Krishnamurthy, Savitri
Woodward, Wendy
Tripathy, Debasish
Yang, Wei T.
Hunt, Kelly K.
DCIS Margins and Breast Conservation: MD Anderson Cancer Center Multidisciplinary Practice Guidelines and Outcomes
title DCIS Margins and Breast Conservation: MD Anderson Cancer Center Multidisciplinary Practice Guidelines and Outcomes
title_full DCIS Margins and Breast Conservation: MD Anderson Cancer Center Multidisciplinary Practice Guidelines and Outcomes
title_fullStr DCIS Margins and Breast Conservation: MD Anderson Cancer Center Multidisciplinary Practice Guidelines and Outcomes
title_full_unstemmed DCIS Margins and Breast Conservation: MD Anderson Cancer Center Multidisciplinary Practice Guidelines and Outcomes
title_short DCIS Margins and Breast Conservation: MD Anderson Cancer Center Multidisciplinary Practice Guidelines and Outcomes
title_sort dcis margins and breast conservation: md anderson cancer center multidisciplinary practice guidelines and outcomes
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5604195/
https://www.ncbi.nlm.nih.gov/pubmed/28928852
http://dx.doi.org/10.7150/jca.20871
work_keys_str_mv AT kuererhenrym dcismarginsandbreastconservationmdandersoncancercentermultidisciplinarypracticeguidelinesandoutcomes
AT smithbenjamind dcismarginsandbreastconservationmdandersoncancercentermultidisciplinarypracticeguidelinesandoutcomes
AT chavezmacgregormariana dcismarginsandbreastconservationmdandersoncancercentermultidisciplinarypracticeguidelinesandoutcomes
AT albarracinconstance dcismarginsandbreastconservationmdandersoncancercentermultidisciplinarypracticeguidelinesandoutcomes
AT barcenascarlosh dcismarginsandbreastconservationmdandersoncancercentermultidisciplinarypracticeguidelinesandoutcomes
AT santiagolumarie dcismarginsandbreastconservationmdandersoncancercentermultidisciplinarypracticeguidelinesandoutcomes
AT edgertonmarye dcismarginsandbreastconservationmdandersoncancercentermultidisciplinarypracticeguidelinesandoutcomes
AT rauchgaianem dcismarginsandbreastconservationmdandersoncancercentermultidisciplinarypracticeguidelinesandoutcomes
AT giordanosharonh dcismarginsandbreastconservationmdandersoncancercentermultidisciplinarypracticeguidelinesandoutcomes
AT sahinaysegul dcismarginsandbreastconservationmdandersoncancercentermultidisciplinarypracticeguidelinesandoutcomes
AT krishnamurthysavitri dcismarginsandbreastconservationmdandersoncancercentermultidisciplinarypracticeguidelinesandoutcomes
AT woodwardwendy dcismarginsandbreastconservationmdandersoncancercentermultidisciplinarypracticeguidelinesandoutcomes
AT tripathydebasish dcismarginsandbreastconservationmdandersoncancercentermultidisciplinarypracticeguidelinesandoutcomes
AT yangweit dcismarginsandbreastconservationmdandersoncancercentermultidisciplinarypracticeguidelinesandoutcomes
AT huntkellyk dcismarginsandbreastconservationmdandersoncancercentermultidisciplinarypracticeguidelinesandoutcomes